MEDICARE: WALGREEN CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy
4	333600000X	Pharmacy	24227	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4538077	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609881796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	MS 790
City	:	DANVILLE
State	:	IL
Zip	:	61834-4509
Country	:	US
Telephone Number	:	217-709-2351
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	156 FM 518 RD
Second Line	:
City	:	KEMAH
State	:	TX
Zip	:	77565-3215
Country	:	US
Telephone Number	:	281-538-3989
Fax Number	:	281-538-5619

Authorized Official
Title or Position	:	MANAGER
Name	:	KIRA L TAYLOR
Credential	:
Telephone Number	:	217-709-2351

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/20/2023

Similar Medicare Providers

1023346129 — MR. PARTHIV WAGHWALA R.PH
Practice Location Address:

156 FM 518 RD
KEMAH, TX
77565-3215

Practice Phone: 281-538-3989
Practice Fax:

1891793816 — CARL H BECHTEL D.C
Practice Location Address:

2129 FENWOOD ST
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77565-2117

Practice Phone: 281-344-4700
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1215910070 — DELORIS NELSON LPC
Practice Location Address:

1006 S SHORE DR , 3
KEMAH, TX
77565-2490

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1699703645 — GEORGE PERRY GRIMES PHD
Practice Location Address:

480 MARINERS DR
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1831116979 — WAL-MART STORES TEXAS LLC
Practice Location Address:

255 FM 518 RD
KEMAH, TX
77565-3219

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Practice Fax:

1437173390 — DR. STACIE LYNN HOLT D.D.S
Practice Location Address:

1939 LAWRENCE RD
KEMAH, TX
77565-3122

Practice Phone: 281-538-9300
Practice Fax: 281-538-9031

Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

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